ANTI-TTG AMONG CHILDREN WITH CHRONIC FUNCTIONAL CONSTIPATION UNRESPONSIVE TO 6 WEEKS OF TREATMENT OF CONSTIPATION

ABSTRACT BACKGROUND Celiac disease is a glutten induced enteropathy. Some authors recommended screening celiac in children with constipation. There are studies to evaluate celiac disease in children with constipation. But most of them included children regardless to treatment failure. OBJECTIVE The aim of this study was to evaluate frequency of elevated anti TTG in children with constipation after failure to improve during 6 week of appropriate treatment of constipation. METHODS In this cross sectional study, 550 children with prolonged constipation were included. Place of study was Pediatric Gastroenterology clinic of Abuzar children’s hospital. Prolonged constipation was defined as a constipation which failed to resolved after 6 weeks of appropriate treatment. Constipation was defined according to ROME III criteria. After parental agreement, 5 mL of blood was obtained. Serum anti TTG level was measure using ELISA method by Orientec kit. Anti TTG>10 was considered positive if IgA was normal. SPSS version 16.0 (Chicago, IL, USA) was used for data analysis. Chi square, t-test, and Mann Whitney test used for data analysis. RESULTS In this study 550 children (m=277, f=273) were included. Mean age of the cases was 6.8±2.9 year. Anti TTG antibody level was 5.8±2.8 unit/mL. Of these case, 42 (7.6%) had positive anti-TTG antibody. Celiac disease was confirmed in 40 cases after histopathology examination. CONCLUSION Anti-TTG was positive in 7.6% children with chronic constipation who failed to respond after 6 week of treatment. Another multicenter study with longer follow up period is recommended.

Selected Contribution: Sex differences in osmotic regulation of AVP and renal sodium handling

To determine sex differences in osmoregulation of arginine vasopressin (AVP) and body water, we studied eight men (24 ± 1 yr) and eight women (29 ± 2 yr) during 3% NaCl infusion [hypertonic saline infusion (HSI); 120 min, 0.1 ml · kg body wt−1 · min−1]. Subjects then drank 15 ml/kg body wt over 30 min followed by 60 min of rest. Women were studied in the early follicular (F; 16.1 ± 2.8 pg/ml plasma 17β-estradiol and 0.6 ± 0.1 ng/ml plasma progesterone) and midluteal (L; 80.6 ± 11.4 pg/ml plasma 17β-estradiol and 12.7 ± 0.7 ng/ml plasma progesterone) menstrual phases. Basal plasma osmolality was higher in F (286 ± 1 mosmol/kgH2O) and in men (289 ± 1 mosmol/kgH2O) compared with L (280 ± 1 mosmol/kgH2O, P < 0.05). Neither menstrual phase nor gender affected basal plasma AVP concentration (P[AVP]; 1.7 ± 4, 1.9 ± 0.4, and 2.2 ± 0.5 pg/ml for F, L, and men, respectively). The plasma osmolality threshold for AVP release was lowest in L ( x-intercept, 263 ± 3 mosmol/kgH2O, P < 0.05) compared with F (273 ± 2 mosmol/kgH2O) and men (270 ± 4 mosmol/kgH2O) during HSI. Men had greater P[AVP]-plasma osmolality slopes (i.e., sensitivity) compared with F and L (slopes = 0.14 ± 0.04, 0.09 ± 0.01, and 0.24 ± 0.07 for F, L, and men, respectively, P < 0.05). Despite similar Na+-regulating hormone responses, men excreted less Na+ during HSI (0.7 ± 0.1, 0.7 ± 0.1, and 0.5 ± 0.1 meq/kg body wt for F, L, and men, respectively, P < 0.05). Furthermore, men had greater systolic blood pressure (119 ± 5, 119 ± 5, and 132 ± 3 mmHg for F, L, and men, respectively, P < 0.05) than F and L. Our data indicate greater sensitivity in P[AVP] response to changes in plasma osmolality as the primary difference between men and women during HSI. In men, this greater sensitivity was associated with an increase in systolic blood pressure and pulse pressure during HSI, most likely due to a shift in the pressure-natriuresis curve.